| NPI | 1083994271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101274320) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: DC MD210002211) |
| 208200000X Plastic Surgery (Licence: MD D0093948) | |
| 208200000X Plastic Surgery (Licence: NC 2018-02093) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2022-04-13 |